Create a Booking Form for iPhone/iPad Repair

Hi, I am the CEO of an iPhone repair business in Sydney, Australia. We have been doing "on-demand" iPhone repair across Australia for over a year. We travel to the customer to complete their phone repair. I am fairly technical and have a number of years of system design, database and programming experience but I have no experience with web development (and no time to learn) which is why I am looking for a freelancer. Currently we are using [login to view URL] to collect our customer bookings but this has lots of limitations, can't be hosted on our website directly, and lacks address validation. I would like you to build a booking form that is almost identical to [login to view URL] Key requirements - Booking form to be hosted on our wordpress website. - We only need iPhone and iPad repair types at the moment - Ability to easily add new models of iPhone and iPad later (perhaps via configuration file or database entry) - We need to capture the customer's address before generating the price quote, because the price is dependant on their address (postcode/zipcode) - Ability to easily manage price/zipcode mapping via a configuration file - Completed bookings to be saved to a database, and a JSON call made to transfer the data to the job dispatch system - Ability to ask some extra questions of the customer, for example if they select screen repair, give them the option to purchase a screen protector